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GG1980712: Group Prenatal Care Training for Indigenous Women
Five health centers serving indigenous women in North Dakota, South Dakota, Minnesota, Nebraska, and Montana are requesting our help to develop group prenatal care in order to reduce infant mortality and negative outcomes among the pregnant women in their communities. Indigenous communities face the highest rates of preterm birth and infant mortality in the Midwest, and have the highest rates of negative outcomes among mothers.
Group prenatal care is an evidence-based intervention that can reduce preterm birth—the number one cause of infant mortality—and improve many outcomes for the pregnant mothers, such as increasing breast-feeding initiation, reducing smoking, etc. Group prenatal care is consistent with native culture, similar to 'talking circles'.
This Global Grant will provide training in group prenatal care to all five communities in 2019. Each site will receive start-up funding for two years, data and technical support, and an opportunity to meet together at the start and end of the grant to facilitate problem solving and collaboration.
Goals: ultimately, the project will reduce preterm birth (thus, reduce infant mortality). Health outcomes for pregnant mothers will also be improved. Trust in the medical community and personal empowerment over health will increase prenatal care attendance, which is strongly related to improved health for babies and pregnant women.
Timeline: The Global Grant components are complete as of October, 2018! We are in need of financial commitments to submit this Global Grant application as soon as possible—we aim to submit by the end of January, 2019. Financial support would be need to be submitted by approximately March 2019, upon grant approval. Training is planned for June 2019 with a final follow-up session in June 2021.
INDIGENOUS HEALTH CENTERS
1. St. Vincent Health Center and Satellite Indian Health Services Clinic in Lame Deer, Northern Cheyenne reservation, 1233 N 30th St, Billings, MT 59101 Phone: 406-237-7000, https://www.sclhealth.org/locations/st-vincent-healthcare/about/
2. White Earth Home Health Agency/White Earth Service Unit for Indian Health Services (IHS), White Earth Service Unit, Indian Health Service, Ogema, MN 56569 https://www.ihs.gov/bemidji/healthcarefacilities/whiteearth/
3. Santee Sioux Health Center, 110 S. Visiting Eagle ST. Niobrara NE 68760 http://santeesiouxnation.net/santee-health-center.html
4. Elbowoods Memorial Health Center and Three Affiliated Tribes/MHA Nation MHA Nation | Three Affiliated Tribes, 404 Frontage Road New Town, ND 58763 http://www.elbowoodshealth.com
5. Rosebud Health Rosebud Comprehensive Care Facility, Hwy 18 Soldier Creek Road Rosebud, SD 57570 https://www.ihs.gov/greatplains/healthcarefacilities/rosebud/
These centers conducted formal and informal community assessments and assessed their ability to successfully begin and sustain the program. The five sites have started conducing monthly phone calls together to discuss potential challenges they may face in implementing Group Prenatal Care. They have already submitted letters of support from their Health Centers, Indian Health Services (if required), and their tribal councils.
MARCH OF DIMES
March of Dimes will provide training in group prenatal care and is willing to offer support in kind for this project. March of Dimes emphasizes health equity and thus is willing to provide staff time to developing the partnerships required for successful completion of this grant. They also have a long history of partnership with Rotary, beginning in the early days of polio eradication.
UNIVERSITY OF NORTH DAKOTA
This grant will support one public health graduate student who is from an indigenous community and who hopes to continue working with native communities using their Public Health Master's degree. Their participation in this project will leverage the project results to connect with additional native communities in the Midwest, scale up the project nationally, and ensure that results are gathered, processed, and disseminated in a culturally-appropriate and professional manner. The partnership with the University of North Dakota graduate program will bridge gaps between the native communities and the broader health and academic communities and will work closely with March of Dimes local and national staff to ensure this project has national implications.
INDIGENOUS GROUP PRENATAL CARE EXPERT
A native facilitator will be selected by an interview with the FMAM Rotary Club from a pool of applicants. The person would ideally be from an indigenous community in the Midwest, be highly interested in group prenatal care development in native communities, have wide experience developing programs in native communities, and have experience in a clinical setting. One appropriate candidate has already volunteered, from the participating Montana health center. March of Dimes has offered to provide training with national Group Prenatal Care March of Dimes staff for this individual to become an expert.
HOST ROTARY CLUB: Fargo-Moorhead AM, Fargo, ND, USA, District 5580
INTERNATIONAL ROTARY CLUB SPONSOR: Rotary Club of Thunder Bay (Fort William), Thunder Bay, ON, Canada, District 5580
Rotary Clubs will be responsible for:
1. administrative tasks, including extensive workload arranging regular monthly billing/reimbursement components for the many sites and partners involved.
2. identifying and providing guidance and support for appropriate graduate student and native group prenatal care expert. The host Rotarians will work with the university and with health centers to identify individuals, arrange supervision plans, and get paperwork in place with the university and health center to create a billing mechanism.
3. participating and preparing the training at the start of the grant and the follow-up session at the end of the grant. Tasks will include: printing of banners, pamphlets, training booklets and materials for the training; arranging the training site including location/meals/hotel blocks/IT support; participate during training session and follow-up session.
ASSESSMENT OF NEED
Each of the five sites conducted community assessments, per requirements of the Rotary International Global Grant process. In summary, the assessments revealed:
1. a need for increased cultural and spiritual connections for pregnant moms,
2. the communities' belief that they would benefit from having more social support and holding group sessions for pregnant women.
3. a lack of trust in medical providers, which group prenatal care overcome by bridging the gap between the formal health system and the trusted professionals and paraprofessionals working in the community.
Note: Individual community assessments are available upon request and will be submitted with Global Grant application.
Initial training costs and start-up funds are the primary barrier for communities who wish to implement group prenatal care. Further, when group prenatal care is first implemented at a health centers, technical support is often needed for the program to overcome challenges and gain momentum. After this initial start-up period when training, additional funds and technical support are needed, prenatal care—including group prenatal care—is a covered Medicaid benefit.
Therefore, this grant will help sites overcome the major barrier to implementing group prenatal care: technical support, training and start-up funding. After this two-year period, the sites will be able to sustain the cost of group prenatal care after the two-year grant period.
BUDGET AND FINANCIAL SUPPORT NEEDS
The total budget for this project is approximately $184,000 and includes the following components:
1. Training: All health centers will be trained in group prenatal care techniques in a 2-3 day session, provided by March of Dimes. Transportation, room, and board will be provided to attend the training.
2. Individual site support: each site has submitted individual budgets for start-up supplies, such as blood pressure cuffs and other medical supplies, a stipend for elders or other guest speakers to bless the session and/or provide specialized discussions on substance use or other topics of interest, cultural crafts to connect the women with their culture, healthy snacks for the participants, and booklets or other materials for the participants. All sites will receive technical support and data support from March of Dimes, an indigenous group prenatal care expert, and a graduate student at the University of North Dakota.
3. Collaboration/partnership opportunity: At the end of the grant period, providers will meet again to discuss grant results and plans for follow up.
We need to raise nearly $34,000 from clubs and individuals in order to leverage funds from District 5580 ($67,000) and The Rotary Foundation ($84,000). To date we have received pledges of approximately $22,000, but we need your support!